Earlier I did not get a chance to
watch the episode completely. And I got carried away by reactions of people in
websites, various articles published online etc. and thought the show was done
irresponsibly. Though I didn’t express such feelings in any of the public
forums, I don’t feel nice to have felt that way in the first place. Here I am
today and I stand corrected.

After watching the show end to
end, I do not have any disrespect towards Aamir Khan or the show organizers,
instead I found the show to be quite good. I did find some improvement areas
also which probably caused some of the controversy.

-People
who oppose did not get the scope right: First and
foremost thing is the scope of the show, which I think many people failed to
realize properly (especially those who opposed the show).

Aamir Khan wholeheartedly
agreed that doctors are humans too and mistakes can happen (and are
acceptable), he never wanted to question such things and hence kept that debate
aside. His objective was mainly to focus on deliberate wrong doings by
healthcare professionals driven by pure greed. He even kept aside negligence, and
the focus area was intentional fraud only.

In other
words, the scope of the show is as follows:

oUnintentional
Mistakes

oNegligence

oDeliberate Fraud

Negligence can
be a very touchy subject and hence I appreciate that he kept it aside.

In short, I strongly
feel that there is absolutely no reason why good doctors should feel bad about
this show.

-Who
said doctors should not make money?: This is a
classical question – is it okay to make big money through noble profession who
treat suffering people?

Aamir never
said doctors should not make big money; in fact he showcased how Dr. Devi Prasad
Shetty and his colleagues make good money along with providing great service. All
he said was “If you are able to get a medical seat, I am sure you are quite
smart; if your primary intention is to make money then why don’t you try
another profession because you might be smart enough to make money in those
fields as well”. I don’t see anything wrong in that argument/request.

Is there
anyone who says that it is perfectly okay if someone entering medical field considers
money as the highest priority? And if someone really feels so, I suggest that
they raise their viewpoints and try to change MCI’s code of ethics.

Also, if a
doctor openly and officially charges higher fees for a legitimate and quality
treatment, I am sure Aamir or anyone won’t raise fingers at such a doctor.
Deciding charge for his/her services is a doctor’s right. But a doctor should
not cheat patient for money – that’s the main message here.

-Deliberate
fraud cannot be justified: In many cases doctors may be
working under tough conditions – in such cases “unintentional mistakes” can
happen, sometimes frustration may lead to negligence also (about which I am
sure genuine doctors will repent later). But fraud? NO argument can justify deliberate
fraud against patients.

-Pharmacies,
Labs: It is well known fact that non-doctor
wings of healthcare profession cannot exist independently on their own i.e.
pharmacies, labs etc. If doctors are not corrupt, it is not easy for them to be
largely corrupt on their own. So, in most of the cases (there may be
exceptional cases) any frauds in such places can be traced back to corrupt
doctors or doctors who don’t have will/courage to voice against them.

I found the
example highlighted where Dr. Anil Picchad, a lab owner, showed tremendous
courage to overcome the corrupt system highly appreciable (although he did it
only after getting inspired from some personal tragedy). I hope this acts as an
inspirational example for many people.

-Drugs:
How many common people are aware of the term Drug Mafia? The show threw some
light on this. If a large quantity of ‘generic drugs’ are being exported, then
is it not an indication that they are quite good? Let us not mix up fake drug
issue and blame generic drugs for failed cases. The proposed idea of government
opening generic drug stores everywhere definitely seems to be a good idea, and
this was later acknowledged by Dr. Rai from IMA also in one of the TV debates.

Now, I hear
some doctors alleging that generic drugs are not really as effective as branded
drugs. With all due respect, I request such doctors to provide more examples,
scientific data for such claims. Even if they want to speak from their
experience, I would love to read more on that.

As a non
medical person, from my perspective, when successful doctors like Dr.
Deviprasad Shetty and important person like Dr.Rai from IMA endorse generic
drugs, I believe burden of proof lies on the people who oppose.

Note:
Dr.Deviprasad Sheetty and Dr. Rai endorsed generic drugs in a different debate,
not in this show.

-Role
of MCI: I found the statistics provided mind
boggling i.e. not a single doctor is stripped off his/her license in last 4
years. I also found the episode of retired army person joining and retiring
without being able to improve the system; I found it extremely concerning.

BTW, what did
MCI achieve in last few years? Did it achieve anything at all? At least the
chief of MCI didn’t bother to highlight any of MCI’s achievements. So, viewer
is completely justified in assuming that MCI had completely lost track until recently
and now struggling to bounce back.

I found
Aamir’s efforts to extract certain concrete answers and promises from MCI chief
commendable.

-Medical
Colleges: Forget about number of colleges for a
moment; let us assume that government did not take initiatives to meet the
demand and hence private entered the arena and filled this gap. Maybe their
contributions have to be appreciated in this regard. But let us look at
following questions:

oIs
it not an open fact that there is huge amount of donation (cash payment) for
management seats? Is it not a fact that person with money but less merit can
get a seat through such means?

oIs
it not a fact that people who spend big money on education will also try to
make big money and in turn influence/corrupt many others around?

oIs
it not a well known fact that most private medical colleges are built using
black money and owned by influential people?

oIs
it not a fact that many staff are temporarily brought in and showcased for the
accreditation purposes?

I
am glad that all these were told openly in the show. I am also glad to see a
suggestion that more government medical colleges should come up.

Note:
Many people get medical seats through reservations also even though they don’t
have high merit or passion. Personally I am against such an idea, will take it
up separately sometime.

-Case
of mass hysterectomy: Even in so called developed
western world now this is a controversial subject. In the example highlighted,
we can see a clear example of fraud. And Aamir insisted MCI chief to take a
look into that specific case and take some action – I appreciated this
perseverance.

-Case
of appendicitis: This case looks genuine and
sends out an alarm. Appendix is considered as an ‘unnecessary’ body part and
removing it won’t affect any body function. Hence, it probably becomes easier
for a fraudulent doctor to simply advise appendicitis when there is no real
need.

-Case
of Liver Transplantation vs. Gastroenteritis: This
case looks genuine because victim was equipped with sufficient information.
This is a scary example because two doctors together played the trick on
victim. Victims were lucky to escape without any physical harm or loss.

Again I would like to repeat, I
found the intent and spirit of the show good, hence I don’t see any reason to
oppose it. However, I could find several improvement areas and perhaps even
some mistakes in the show.

Degree
of fraud: Just because we talk about ultimate
ethics that no fraud can be justified, I don’t agree that all frauds are of
same degree or some cannot be easily categorized as fraud itself. For ex: Commission/cuts
cannot be equated to suggesting a totally unnecessary surgery. Aamir should
have really highlighted this practical aspect though at one place he does say
that ‘people who violate rules most’ should be first dealt with.

Considering
all practices that are formally classified as frauds, by and large we can identify
4 categories:

Category
1: Here patient is not directly affected;
this is a very mild form of fraud (technically) and in many cases we can see
convincing justifications.

-Taking commission/cuts or gifts
from drug companies and prescribing their drugs only if they are effective and
not overly expensive

-Taking commission/cuts or gifts from
pharmacies, labs etc. and prescribing their services only if they are effective
and not overly expensive

-Taking commission/cuts from other
doctors and referring to them only if they are good and not overly expensive

Category
2: Here patient’s health is not affected
but pocket is; sometimes this might result in inconvenience too. However, in
practice most doctors do try to spare poor people (Some do feel that poor
people should go to government hospitals/doctors if they can’t pay – a
debatable topic, isn’t it?)

-Charging poor people extra when
their treatment should be covered by some government scheme (In this case,
sometimes patients voluntarily ask for better facilities and pay extra too)

-Prescribing unnecessary
diagnostic tests that are not really harmful to the patients

-Hospitalizing patients early or
discharging late without a strong need

Category
3: Here not only patient ends up paying
more money, patient’s health and body is also compromised to some extent.

-Subjecting patients to
unnecessary diagnostic tests that may have small/big risks associated with it.
For ex: multiple X-Rays

-Prescribing costly and also
inferior drugs

-Prescribing unnecessary drugs or
injections

Category
4: This is the worst case where patient not
only has to cough up huge money but also go through lot of physical suffering,
and perhaps face disability/death also.

-Prescribing/Performing procedure/surgery
instead of first trying well known treatments through drugs

-Prescribing/Performing totally
unnecessary procedure/surgery

So, when Aamir
told MCI chief that numerous doctors would lose their license as per his
research team, I am sure most of such doctors belong to category 1, and some
will belong to category 2, even smaller number in category 3 and very few in
category 4. But Aamir failed to make this distinction.

I wholeheartedly support taking
strict actions against category 4 frauds. Frauds in other categories are best
dealt with in milder fashion and systematically eradicated through long term
planning and policy changes instead of targeting individual doctors.

-Case
of Mrs. Seema Rai’s death: I consider inclusion of this
example as a “Media Negligence”. I am sorry for the loss of the family
involved, but who is right and who is wrong – we cannot pass judgment here; arguments
from both parties look very convincing for a common man.

Instead, the
research team could have easily picked up a case where the case is settled and
in favor of the patient. Now, many people’s concentration is simply on this
case and not on the macro level picture. Unfortunately, this has hurt the original
intent of the show.

-Case
of finger amputation: I am sorry to say, but this doesn’t
look very convincing to me. If it was a case of fraud, would any doctor
himself/herself tell the patient that the first operation was not necessary?
Again, I believe it was a poor choice of case that the team picked up. Or it
should have been presented better.

Or maybe its
another doctor who made such a remark that original surgery was unnecessary.
Such thing happens due to jealousy also and need not be an example of fraud.
The case should have been investigated more seriously before presenting on TV.

-State
of affairs in government hospitals: Aamir should
have highlighted the fraud happening in government institutions also. It is a
well known fact that in many such places doctors take fees illegally or ask
patients to come for private consultation later, free drugs are sold for money,
budget allocated for various purposes are eaten up etc. (and the commission
goes all the way up). Some RTI magic would have got his team some interesting
data over there.

-Fake
drugs: I am ignorant about exact extent of
this issue and related statistics, but I keep hearing that issue of fake drugs
is also growing. Maybe the show could have covered something about this, along
with the issue of generic drugs.

-Interview
with drug controller: It would have been great if
someone from drug controlling authority also had attended the show and
interviewed by Aamir. Lets remember that recently one more controversy had come
up where some high profile doctors had endorsed some drugs without proper
clinical trials.

-Interview
with private medical college owners: Aamir could
have invited one of the private medical/dental college owners and asked some
unsettling questions or could have showcased their efforts if they are not into
fraudulent practices.

When
government hasn’t setup a medical college to meet the demands, is it unethical
if private parties try to setup a commercially viable education business? Which is better of the evils? Costly doctor
or no doctor scenario?

If I am not
wrong, recently in Karnataka private schools were strictly prohibited from
taking donations – it would be interesting to see reasons behind it and how
implementation is happening. Personally, I don’t find it wrong if a private
school offers better facilities and charges higher. However, exactly when and
where it creates social divides and long term problems is an interesting issue.

-Commission/Cuts
is not a simple issue: I am sure that the
commission/cut culture is not a rampant practice. However, the show gives an
impression that most doctors make huge money through such practices. I don’t
agree with it.

Even if the
practice does exist in some places, the percentages highlighted in the show are
quite impractical for small towns and rural areas. In any case, this topic
needs in depth analysis from practical angle:

oLets
say in one area the commission/cut culture exists. Lets say one of the doctors
decides not to take cut/commission from a private lab owner. Does it mean that
lab will simply transfer the benefits to patients?

§When
other doctors continue to demand cut/commissions, the lab cannot decrease
charge of a particular test only when it isprescribed by one particular doctor. Such a thing is impractical.

§Even
if all the doctors agree not to take cut/commission, the lab owner still need
not reduce the charge when his/her charges are comparable to many other
towns/cities around

oLets
say most doctors in a town are not taking cut/commission from pharmacies or
labs. A new doctor comes and he demands commission from a lab. Why would lab
oblige easily? If doctor tempts the lab through ‘basin tests’ proposal as
explained in the show, doctor’s proposal might sound tempting. Otherwise, it
wouldn’t be possible for lab to give commission to doctor.

oLets
say most doctors in a particular town make Rs.100/- for a particular treatment;
lets say that the money is a fair charge. But lets say that Rs.50/- comes
through consultation charge and rest comes through commission from labs. Now,
lets say a new doctor Dr.D comes to the town and he/she wishes to be honest.
But Dr.D also wishes to make Rs.100/- for that treatment (remember? I said it
is fair money) but doesn’t want to accept any commission from the lab. Dr. D
will have to charge Rs.100/- to the patient and lab might not reduce their
charges just for this one doctor. Eventually patient coughs up more money – can
Dr.D sleep with clear conscience even though he/she did nothing wrong?

oOverall,
what I am saying is that the commission/cuts practice is not as bad it seems
like, as long as practices don’t heavily belong to category 2 & 3. And most
doctors feel that category 1 is not really a fraud – if Dr.Deviprasad Shetty
was able to work out some economics, these doctors also have, I don’t see a big
deal in that. Also, people who belong to category 2 & 3 conveniently put
themselves in category 1 and it is very hard to prove it. Banning this is like
banning alcohol, quite impractical. If deserving (meritorious and passionate) candidates
get medical seats at cheaper price, then this problem will automatically get
reduced.

-Budget
for healthcare: Just talking about increase of
1.4% to 6% of budget is not sufficient. Along with percentage wise comparison,
absolute comparison is also important. Many drugs and equipment are from MNCs
and cost pretty much same in western world and here, if I am not wrong. Hence,
speaking absolute numbers and dividing by population is very important. Then we
would get more clarity on what money India has and what level of service we can
really expect.

Based on my observation, some
doctors and associations got annoyed and angry about the show because of following
main reasons:

-True intent of the show was not
understood by them properly

-They felt some of the examples
shown were not picked up correctly and that brought down value of the show

-They felt annoyed with no
differentiation between various degrees of fraud, when it is pretty much
debatable whether some of the things should be or should not be termed as fraud
under various challenging circumstances

-They felt various problems they themselves
face are not showcased

Regarding
highlighting several challenges faced by doctors and hospitals themselves:
There are numerous challenges with respect to quality and price of various
products/services from others, attitude of patients and staff, issues due
corrupt systems around etc. For more details you can refer to another article
that I wrote recently: Challenges faced by Private
Hospitals in Kerala

However, such difficult
situations can only justify the following:

-Unintentional mistakes

-Lesser quality of services

-Increased charges

-And (unofficially) maybe perhaps
negligence in some rare cases due to frustration/overwork

But the scope of this show was
limited to fraud, and it is unreasonable
to expect a detailed coverage of all the issues doctors and hospitals face,
because none of these challenges should justify fraud anyway. I hope this
makes sense.

Please don’t do the same mistake
what I did – if you haven’t watched the entire episode end to end, I request
you to kindly go through it and then comment.

Overall I found that Aamir showed
utmost respect to the good doctors throughout the show; he treated the medical
students also nicely and ensured that they left with lot of motivation. Even in
his concluding remarks, Aamir clearly highlighted that there are numerous
doctors who are practicing with very good intent and with patient welfare as
highest priority, and he saluted such doctors. However, some of the aspects of the show could
have been better thought through, including the examples chosen.

On the other hand, I feel sad
that some doctors and their associations chose to oppose the show and Aamir
instead of gracefully approaching with more constructive thoughts to improve
the situation. I certainly feel sad that IMA opposed the show and demanded
apology.

Your comments/feedback/criticism
are always welcome.

Disclaimer: Though I am not a healthcare providing
professional myself, I am associated with and working in a private healthcare
providing institute in Kasaragod, Kerala in many ways. The views expressed here
are purely mine and do not reflect views of any other individual or firm.